CONDOMINIUM / APARTMENT QUESTIONNAIRE

Applicant Name:
Address:
City / State / ZIP
Telephone/FAX:
Email/Website:
Business Entity:	SELECT FROM THE FOLLOWING Individual Partnership Corporation Association Other
Location Address:
City / State / ZIP
Current Building Amount Effective Date Deductible Year Built Number of Units Number of Stories Type of Construction SELECT TYPE OF CONSTRUCTION Frame Masonry Stucco Concrete Square Footage of All Buildings Number of Buildings Percent of Units Rented Percent Vacancy Type of Parking Type of Roof Number of Pools / Spas Sprinkler System YES   NO Directors & Officers Coverage Desired?  YES   NO Commercial Liability Umbrella Desired?    YES   NO Claims History (over the last 5 years) Number of Claims Approximate Amount Paid Claim Details
To Submit Request: -- Complete Form, Print then  FAX to (415) 454-8311  or

Please Note: Our Agency Will Contact You Within the Next Business Day After Submitting REQUEST